Wednesday, March 19, 2008

Use Patient Survey’s to Measure Health Care Wait Times

What is the gold standard to measure wait times? Both Canada and the UK have set up various systems that connect to primary care hospitals (see Ontario Wait Time Strategy for details) to measure health care wait times. But the data is calculated from the intention to treat date and is only from a handful of larger hospitals. Although it measures most major surgery, it misses a lot. Since funding is targeted to these figures, items that fall of the radar (like me) suffer. I cannot find a discussion about the accuracy, sensitivity or specificity of measuring health care wait times in my searches. There is plenty of data on mean vs. median, date of referral vs. date of intention to treat but nothing about a gold standard.

Accept that wait time is a good yardstick of health care efficiency then the question becomes what is the gold standard to measure health care wait times? The simple answer is that health care wait time should be from when the patient first decides to act on a problem until it is diagnosed or treated. Therefore, we need to survey patients to determine how long they’ve waited, not look to institutions that have a lot at risk by not meeting targets.

The problem is that the data can be easily “rigged” by the people or institutions to meet targets by not accepting referrals, decreasing patient accessibility or delaying diagnosis while waiting on tests. I believe this creates a “false negative” where waiting is truly happening when the “diagnostic test” shows that it is not. See the NHS doc blog about a situation where the NHS is trying to meet an 18 week deadline and the data is being manipulated or the BBC about ER’s leaving patients in ambulances to meet a 4-hour window imposed by the government. More statistics also increases the burden on staff and misses smaller institutions.

Once validated, patient surveys are inexpensive (if on-line) and accessible to most patients. They will increase variation but the shear number of survey’s should make for meaningful comparisons. It doesn’t matter whether it is cancer surgery or a headache once we have a gold standard, other more automated tools could be used to make measurements. But I don’t think they’ll be needed.

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